Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus

INTRODUCTION Cocaine abuse is a relevant public health issue which causes medical, psychological and social drawbacks. Only limited data are currently available on outcomes of acute coronary syndromes (ACS) in cocaine-addicted patients. The aim of this study was to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry, with a focus on in-hospital outcomes. METHODS We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 1 January 2007 to 31 December 2018. Baseline and in-hospital data of ACS patients with self-reported regular cocaine abuse were compared with the remaining AMIS Plus population and a sex and age-matched group of non-cocaine user ACS patients (ratio 1:5, 540 patients). Primary endpoints were in-hospital death and major adverse cardiac and cardiovascular events (MACCEs). RESULTS A total of 20,036 patients were included in the AMIS Plus registry for ACS in the study period, of whom 110 (0.5%) reported regular cocaine abuse. As compared with the remaining AMIS population, cocaine users were significantly younger (46.4 ± 10.8 vs 66.4 ± 13.2 years, p <0.001), presented more frequently with out-of-hospital cardiac arrest (11.8% vs 4.7%, p <0.001) and ST-elevation myocardial infarction (68.2% vs 54.7%, p = 0.007). Of the traditional cardiovascular risk factors, there was a higher incidence of positive family history and active smoking, but a lower incidence of arterial hypertension, diabetes and obesity. In-hospital mortality (3.6% vs 4.4%, p = 1) and MACCEs (5.4% vs 5.5%, p = 0.83) were comparable. When compared with an age-matched non-cocaine user ACS population, cocaine users were more frequently smokers (87.6% vs 63.6%, p <0.001) but less frequently obese (10.4% vs 25.6%, p = 0.001). Clinical presentation was comparable between the two groups. However, cocaine abuse was associated with a higher incidence of in-hospital death (3.7% vs 0.7%, p <0.05) and MACCEs (5.6% vs 1.3%, p <0.05). CONCLUSION Cocaine abuse increases the risk of mortality by a factor of 5 and the risk of major adverse cardiac and cardiovascular events by a factor of 4 as compared with a sex and age-matched population hospitalised after an acute coronary syndrome.